Residents on the Move: Using Mobility to Reduce Nursing Home Falls

Members of the mobility team walk with a resident.

Falls are the leading cause of both fatal and non-fatal injuries for adults over the age of 65, resulting in 2.8 million emergency room visits and over 800,000 hospitalizations each year, according to the Centers for Disease Control and Prevention (CDC). To prevent these injuries, nursing homes across the country have begun implementing innovative strategies to reduce falls in their facilities while still maintaining quality of life for their residents. One such strategy developed by a team at Maple Lawn Medical Care and Rehabilitation Facility in Coldwater, Michigan, has been wildly successful.

After hearing a presentation about the danger of fall alarms and the impact they have on falls, Maple Lawn Administrator Jayne Sabaitis decided that something needed to be done.

“We counted up how many fall alarms we had in our building at the time and it was 65, and we only have 114 patients – so more than half had fall alarms,” said Sabaitis. “We decided we needed to do something to work towards getting rid of these, so we talked to another facility that had already gone through this process and came up with the idea to implement a mobility program.”

This process started with the creation of a mobility team, comprised of two registered nurses (RNs) and several certified nursing assistants (CNAs), responsible for overseeing the mobility program. Next the mobility team identified “target residents” who were either on the border of losing independence or had experienced recent falls, and worked to build a strategy to address their needs. The strategy the team developed focused on two components: increasing mobility for residents through walking and exercise, and decreasing the use of fall alarms throughout the facility.

“They (mobility program CNAs) have a list of target residents that they walk every day, or at least approach and attempt to walk,” said Lindsay Hasten, RN at Maple Lawn. “We also do an exercise group every day that varies: we do drumming classes, we’ve had people come in and do yoga and Tai Chi.”

According to Sabaitis, keeping the residents engaged in exercising and moving has had a significant impact on their overall well-being, as well as the well-being of the facility as a whole.

In addition to the exercise and walking programs, the mobility team developed a new algorithm for the placement of fall alarms in their facility, including the introduction of a 72 hour limit for all alarms. While most of the staff, residents and family members were supportive of walking and exercise classes at Maple Lawn, some were reluctant to reduce the use of fall alarms.

“A lot of staff members were comfortable having fall alarms and they thought that those fall alarms were actually preventing falls,” said Sabaitis. “Once we educated them that they weren’t preventing falls and they saw how we had less falls (without the alarms), they bought into the program much more.”

Some of the residents’ family members were also reluctant to remove fall alarms from the facility because they feared for the safety of their loved one. To diminish their fear, members of the mobility team reached out to all of the concerned family members to educate them on how fall alarms actually cause falls and decrease the overall well-being of residents. While these one-on-one discussions helped family members buy into the mobility program, the positive changes in the residents were the most impactful.

“Once they saw improvement in their family member they decided that it was a great idea,” said Sabaitis. “Some of them haven’t seen their parent or loved one walk in a long time, but they worked so hard in exercises that now they’re walking.”

As a result of the mobility program, Maple Lawn has been able to dramatically decrease their use of fall alarms from 65 to 5 while simultaneously decreasing the total number of falls in their facility – dropping in the overall fall percentile from 31 to 12 percent. But the impact of the mobility program goes well beyond reducing falls – the overall well-being of the residents and environment of the facility has drastically improved.

“When people exercise they release endorphins and it causes them to get happier, and that’s something we didn’t really anticipate when we started the program,” said Sabaitis. “We started with 27 residents on antipsychotics, and now we’re down to 13. And the overall facility is much quieter and more peaceful.”

To those thinking of replicating the program, Sabaitis said the most important thing is to be flexible and remember that staff education is the key to success.

“The key is that we’re flexible and we just try to be here for the residents,” said Sabaitis. “It’s really been successful, much more successful than I ever anticipated it would be.”

—This success story is from the December 2016 issue of Nursing Home Update, the Lake Superior Quality Innovation Network’s free newsletter for hospital quality improvement in Michigan, Minnesota, and Wisconsin. Join our email list.